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Asthma mortality is triggered by short-term exposures to ambient air pollutants: Evidence from a Chinese urban population
Atmospheric Environment ( IF 5 ) Pub Date : 2020-02-01 , DOI: 10.1016/j.atmosenv.2020.117271 Yunquan Zhang , Qianqian Xiang , Chuanhua Yu , Zhiming Yang
Atmospheric Environment ( IF 5 ) Pub Date : 2020-02-01 , DOI: 10.1016/j.atmosenv.2020.117271 Yunquan Zhang , Qianqian Xiang , Chuanhua Yu , Zhiming Yang
Abstract Background Short-term exposure to ambient air pollution (AAP) has been widely linked to asthma morbidity such as outpatient and emergency visits and hospitalization. Up to date, however, the acute effects of AAP exposure on asthma mortality remained largely unknown possibly due to the rare occurrence of asthma deaths. Objectives This study aimed to investigate whether the death risks from asthma are triggered by short-term AAP exposures in a Chinese urban population who suffered poor air quality. Methods 1385 asthma death cases were identified from the total 61.3 thousand death records in two urban districts in Wuhan, central China, 2003–2013. We performed a time-stratified case-crossover design and conditional logistic regression models were applied to assess short-term associations of air pollutants (particulate matter with aerodynamic diameter ≤10 μm [PM10], sulfur dioxide [SO2], and nitrogen dioxide [NO2]) along different exposure days with asthma mortality. Results A total of 1385 case days and 4668 control days were investigated during the study period. Daily mean concentrations of PM10, SO2, and NO2 were 116.6 μg/m3, 53.4 μg/m3, and 60.7 μg/m3, respectively. A 10 μg/m3 rise in exposure to SO2 and NO2 at 2 days prior to death (lag 2 days), was associated with increased asthma death risks of 2.9% (odds ratio [OR] = 1.029, 95% confidence interval [CI]: 1.006, 1.053) and 4.3% (OR = 1.043, 95% CI: 1.012, 1.076), respectively. No evident PM10-asthma associations were identified in all subpopulations except for those aged 85 + years (OR = 1.022, 95% CI: 1.001 to 1.044). In our stratified analyses, significant effects of SO2 and NO2 were only observed in female, the older elderly, 7+ years-educated and unmarried persons, as well as those died outside the hospital and in cold season. We observed some evidence for effect modification by age, with p-values of 0.032 for PM10 and 0.051 for SO2, suggesting higher vulnerability to air pollution among the older asthma cases. Conclusions This study provided suggestive evidence for the short-term association between air pollution exposure and asthma death in highly polluted urban areas. Several days’ high-level exposures to air pollutants, particularly SO2 and NO2, may elevate risks of asthma death. Our findings highlighted the potential health benefits from intervention and preventive actions targeted to reducing AAP exposure among asthma patients.
更新日期：2020-02-01
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